| NPI | 1699769414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 188407) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA05210400) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME75738) | |
| Enumeration Date | 2005-09-08 |
| Last Update Date | 2018-09-29 |